Eighteen boys with Factor VIII and/or IX deficiency have undergone a liver biopsy for possible HCV. Liver biopsy was done only after normalization of Factor VIII or IX levels with Factor VIIIi or IX. There was a spectrum of hepatitis C related liver injury. Three boys had normal liver biopsies and were PCR negative. 15 had mild to moderate hepatitis. All children were treated with alpha-interferon which was tolerated reasonably well except for fatigue. 50% of children became PCR negative at 6 months; of the 10 who have finished therapy, all were PCR+ negative at 12 months after initiation of therapy. The significance of this pilot investigation is the following: 1) New information regarding the spectrum of liver histology in HCV-infected hemophiliac children 2) Confirmation of the observation in adults that there can be histologic evidence of hepatitis in the absence of elevated serum amiontranferases 3) alpha-interferon therapy of HCV infected in children.